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Would Legalizing Euthanasia or Physician-Assisted Suicide Undermine the Quality of Palliative Care That Patients Receive?

PRO (yes)

CON (no)

Wesley Smith, JD, Anti-Euthanasia Activist, wrote in his 1997 book Forced Exit:

"Studies show that hospice-style palliative care 'is virtually unknown in the Netherlands [where euthanasia is legal].' There are very few hospice facilities, very little in the way of organized hospice activity, and few specialists in palliative care, although some efforts are now under way to try and jump-start the hospice movement in that country... The widespread availability of euthanasia in the Netherlands may be another reason for the stunted growth of the Dutch hospice movement. As one Dutch doctor is reported to have said, 'Why should I worry about palliation when I have euthanasia?'"

"Hospice commits to the patient and the family that we will take care of them, to nonabandonment... But if euthanasia becomes a standard of practice, too many times there would be a real incentive to do it. There are some patients whose proper care requires time and effort, professional services that aren't necessarily paid for by insurance companies. I might say, 'There has to be an easier way.' I could too easily find myself seeing euthanasia as the simple answer; one that is less time consuming and the least expensive. If accepted, euthanasia could very easily take the place of proper patient care."

Physicians for Compassionate Care wrote in the "Top 10 FAQs" section of their website (accessed on Aug. 14, 2006):

"Once a patient has the means to take their own life, there can be decreased incentive to care for the patient's symptoms and needs. The case of Michael Freeland is an example. Michael had been given a lethal prescription and when his doctors were planning for his discharge to his home from the hospital, one physician wrote that while he probably needed attendant care at home, providing additional care may be a 'moot point' because he had 'life-ending medication'. His assisted suicide doctor did nothing to care for his pain and palliative care needs. This seriously ill patient was receiving poor advice and medical care because he had lethal drugs."

Kathleen Foley, MD, Professor in the Department of Neurology at Weill Medical College of Cornell University and Herbert Hendin, MD, Professor in the Department of Psychiatry and Behavioral Sciences at New York Medical College, wrote in the introduction to their 2002 book, The Case Against Assisted Suicide: For the Right to End-of-Life Care:

"Given legal sanction, euthanasia, intended originally for the exceptional case, has become an accepted way of dealing with serious or terminal illness in the Netherlands. In the process, palliative care has become one of the casualties, while hospice care has lagged behind that of other countries."

Gerrit Kimsma, MD, MA, Associate Professor in Medical Philosophy and Evert van Leeuwen, PhD, Professor in Philosophy and Medical Ethics, wrote in their chapter "Assisted Death in the Netherlands: Physician at the Bedside When Help Is Requested," that appeared in the 2004 book Physician-Assisted Dying: The Case for Palliative Care & Patient Choice:

"Assisting death in no way precludes giving the best palliative care possible but rather integrates compassionate care and respect for the patient's autonomy and ultimately makes death with dignity a real option...

The evidence for the emotional impact of assisted dying on physicians shows that euthanasia and assisted suicide are a far cry from being 'easier options for the caregiver' than palliative care, as some critics of Dutch practice have suggested. We wish to take a strong stand against the separation and opposition between euthanasia and assisted suicide, on the one hand, and palliative care, on the other, that such critics have implied. There is no 'either-or' with respect to these options. Every appropriate palliative option available must be discussed with the patient and, if reasonable, tried before a request for assisted death can be accepted...

Opposing euthanasia to palliative care...neither reflects the Dutch reality that palliative medicine is incorporated within end-of-life care nor the place of the option of assisted death at the request of a patient within the overall spectrum of end-of-life care."

Barbara Coombs Lee, JD, President of Compassion and Choices, said during a Nov. 26, 1997 interview on PBS Newshour, entitled "A Right to Die?":

"Palliative care has been the main beneficiary of the Oregon Death with Dignity Act [which legalized physician-assisted suicide] so far. Since its passage, we've seen a great resurgence of interest in the medical community in palliative care. Hospice referrals have increased by 20 percent, and now Oregon leads the nation in prescription of morphine. This has a salutary effect on end of life care."

Margaret Battin, MD, Distinguished Professor of Philosophy and Adjunct Professor of Internal Medicine, and Timothy Quill, MD, Professor of Medicine, Psychiatry, and Medical Humanities at the University of Rochester, wrote in "False Dichotomy versus Genuine Choice: The Argument Over Physician-Assisted Dying," published as the introduction to their 2004 book, Physician-Assisted Dying: The Case for Palliative Care & Patient Choice:

"Good palliative care, including that provided by hospice, is incompatible with physician-assisted death. Of all the misconceptions and errors perpetrated by opponents of legaliztion, this is perhaps the most damaging in its departure from the truth... The majority of patients in Oregon who chose assisted death under the Death With Dignity Act were enrolled in hospice programs, and the majority of Oregon hospices have chosen to continue to care for those who are considering this choice. In addition, the Netherlands now has approximately one hundred inpatient hospices, and twenty-four-hour pain-control hotlines provide immediate advice for physicians. As several of the accounts of the practice in the Netherlands...show, better palliative care has been very much a goal of medical policy."